A Phenomenal Binomaly: Two Rare Diseases Presenting With Electrical Storm (JACC Case Reports June 2023)-Article: A Phenomenal Binomaly: Two Rare Diseases Presenting With Electrical Storm

Article: A Phenomenal Binomaly: Two Rare Diseases Presenting With Electrical Storm

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This case report details the presentation and management of a 34-year-old man who experienced an electrical storm after performing headstands. Initially presenting with new-onset chest pain and palpitations, the patient's clinical examination and initial diagnostics (including ECG, lab tests, and imaging) hinted at serious cardiac issues. The ECG showed sinus rhythm with diffuse upsloping ST depression, leading to a suspicion of acute coronary syndrome or aortic dissection, warranting further cardiac and respiratory investigations.<br /><br />The case further unfolded after the patient developed ventricular arrhythmias (VAs), during which he exhibited a wide-complex tachycardia and required multiple defibrillations and medications. A CT aortogram and pulmonary angiogram were normal, but a coronary angiogram revealed an anomalous right coronary artery (ARCA) with a slit-like orifice and an interarterial course. This prompted surgical correction plans.<br /><br />Further diagnostics identified refractory hypertension, raising suspicions of a secondary cause, confirmed by the discovery of a right adrenal mass suggestive of pheochromocytoma. The management included treating hypokalemia and hypertension aggressively, and subsequent surgeries addressed both the ARCA and the adrenal mass.<br /><br />Surgical correction of the ARCA was performed successfully, followed by a laparoscopic right adrenalectomy. Histopathological analysis confirmed the adrenal mass as a pheochromocytoma.<br /><br />The case discusses the complexities of managing rare concurrent conditions—ARCA and pheochromocytoma—both of which contribute to serious cardiac complications. It speculates that the headstand might have triggered a cascade of events leading to malignant hypertension and subsequent electrical storm. The report emphasizes the importance of a multidisciplinary approach in diagnosing and managing such complex cases to ensure positive patient outcomes.<br /><br />No conflicts of interest were reported by the authors.

Keywords

electrical storm

headstands

ventricular arrhythmias

anomalous right coronary artery

pheochromocytoma

refractory hypertension

multidisciplinary approach

cardiac complications

surgical correction

adrenal mass